Provider Demographics
NPI:1629368881
Name:DIABETES MANAGEMENT SOLUTIONS
Entity Type:Organization
Organization Name:DIABETES MANAGEMENT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BAXTER
Authorized Official - Middle Name:WRAY
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-397-6386
Mailing Address - Street 1:132 RIVERVIEW DR
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8924
Mailing Address - Country:US
Mailing Address - Phone:601-397-6386
Mailing Address - Fax:866-430-4514
Practice Address - Street 1:132 RIVERVIEW DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8924
Practice Address - Country:US
Practice Address - Phone:601-397-6386
Practice Address - Fax:866-430-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies